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HomeMy WebLinkAbout2598DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -44 BOX 22 'j f . ��. -, re L�,� 1.6 JA60 Ok V L' ELL .. 02598 CERTIFICATE O ONSTRI Located at Owner r `� M'y��1 WER EMUS r PUTNAM COUNTY DEPARTMENT OF HEALTH PROVIDE Division of frivironmental,HwIth Services, Cann% &,,-Y. 10592 PERMIt #, � V 31 5G CTION COMPLIANCE FOR SEWAGE-DISPOSAL SYSTEM P071,/Ad , LLEJ Town or Village Tax ,Kap ,Block lrr `� r Formerly k1�U --o �5!CA"frS �NT Map Lot n Subd. Lot H Separate Sewerage System built by '6" . - — Consisting of i yy7 Gal. Septic Tank and Other requirements Water Supply: Public Supply From 1. Private Supply Drilled By Address - Building Type FAI411 4 No. of Bedrooms Date Permit Issued � 3o SIo Has Erosion Control Been- Completed? garbage grinder been installed? I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the 'standards, rules and regulations, in accordance with'the filed plan, and the permit issued by the Putnam County Department Of Health. •, Date P.E. X R.A. License No. Q , 06 v Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shalt become null and void as soon as a public sanitary sewer becomes available and the approval of the:,private water supply shall become null and void whop a public water supply becomes available. Such approvals are subject t modification or change when, in the' Judgment of the Commissioner of Health, such revocation, modification or change is necessary. r _ Date By Title Rev. 6/85' .'D PU NAM COURN DEPARTMENT OF HEALTH - _ DIVISION- OF_:ENVIRONMENrAL.- HEALTH... SERVICES -.- - - - NI L CA-w, l)av4 LoPicA,,Ir e° Owner or Purchaser of Building t Building Constructed by Location - Street Municipality n� t i'a'�tn-.�C.c. Building Type 3 Section Block Lot WICap�� �Stcs e.S Subdivision Name 3 Subdivision Lot # GUARANM OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the. approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or'assigns, to place in good operating.condition any part of.said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the Certificate -of Construction Compliance" for the = sewage - disposal _syst=M, or repairs made by me to such system, except where the failure to operate proper, y is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of- the Putnam County Department of Health as to .wherher or not tide iaiiure of Uie 5ysLen % o operace eras caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this y of 19 F 2� kJ4 F-A-P, OE- vEZ :v` - General Contractor er)`- Signature Corporation Name (if Corp.) Address E L lhty Fu'Z -D � y l a y ' 3 rev. 9/85 mk Signatur .a--, Title �,.,�, Corporation Name (if Corp.) `1 AJo Address ,��Lo-s FvA-o? by Ms--1-3 i• a P4 * r . _._ ._ _ WLLL U%Jr1rLG11Vly nr,rVni DEPARTMENT OF HEALTH ..._ �i,; �, is- i,�n•�0£_.Er_- v.irr,.nmental,. Health :RSer�ri��s.�:._�,�;.;,_,: PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only - - - - WELL LOCATION j WELL OWNER STREET AOURESS. ToWNIVIELALAIC11Y TAX GRID NUMBER: 11,,P j N �tE: AOOR Ss: PRIVATE A,5�- C-Zm rd ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary KRESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND.IHEAT PUM ❑ ABANDONED 0 BUSINESS O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING 'J4 NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION O REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. I STATIC WATER LEVEL / _l!j ft. DATE MEASURER, 4A7 DRILLING EQUIPMENT ❑ ROTARY ;KCOMPRESSED AIR PERCUSSION ❑ DUG ❑WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 41 ft. MATERIALS: ASTEEL ❑ PLASTIC 0 OTHER CASING DETAILS LENGTH.BELOW GRADE ft. JOINTS: 0 WELDED ' THREADED 0 OTHER DIAMETER in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE THER WEIGHT PER FOOT lb./ft. DRIVE SHOE: 0 YES . NO I LINER: O YES 0 NO SCREEN -- F T AILS- _ _ DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST _ ❑YES -ONO HOURS SECOND GRAVEL PACK O YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping I P P 9 METHdo: O PUMPED it tests were done is in- COMPRESSED AIR , formation attached? BAILED ❑ OTHER ; 0 YES 0 NO WELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- my Well Dia- In FORMATION OESCRIPTION CODE. ft. ft WELL DEPTH It. DURATION hr. min. DRAWOOWN R, YIELD gCm. Land Surface , r WATER ACLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? &YES ONO 9 STORAGE TANK: TYPE;�@y`�f�jL, CAPACITY GAL. PUM HFORMATION I TYPE �•% m Pf`S'th 1 CAPACITY MAKER �� 9 S DEPTH MODEL �_L___- VOLTAGE�H - W NAM�j qq t LtSin. 61 SIG r R _ 1 LAB # Mk„ 002811 Ydrkt6w iNedical :Laboratory, Inca =--- - - = -_� 321 KearScreec Collection Station Used: wn Heights, N. Y. 10598 Carmel Peekskill Yorktown - z caper c„> Director: Albert H. Padovani M. T. (ASCP) Date Taken : J./ T- Date Received: 3/'.3/ "? ;� c Date Reported: -. Collected By: 7ez Referred By.: Sample Source: o L LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA X- Standard P1ate,Count per 1.O ml Z (Agar.plate @ 35 0C) MEMBRANE FILTRATION TECHNIQUE (MFT) Total Coliform ner 100 ml. Fecal, Coliform ner 100 ml Fecal Streptococcus per 1.00 ml "OST PROBABLE NUMBER TECHNIO.UF; (.MPN ) Total Coliform: MPN Index ner 100 ml 'Fecal Coliform: b`.1N Index .per 100 ml OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPLE OF A SATISFACTORY SANITARY QUALITY ACCORDING WATER.STAND.A.RDS, FOR THE PARAMETERS TESTED, AT Albert H. Padovani, ?�.T. (ASCP), Director }(WAS NOT) (NOT APPLICABLE), /NEW YORK STATE DRINKING TIME OF COLLECTION. LEGEND RDS = Recommend Disinfect - ing Water Source < = less than TNTC = Too Numerous Too Count 711 7­1_777 I?ev,, 3186 Division of Environmental Health Services.. _Qzmel, N. V permit # CONSTRU[C TI nN P 3' DISPOSAL SYSTEM, Putnai ',-,Town or Nithwe -0scalArapa e Tax Aftio —3.3 Subdivision Name � 0 Revision � Date of P6A'ous Approval _ftmfor.d'! '10513 Mailing Address .44 North Central Avehue � . Building Type fami.. re i dence Lot Area�, 5-1-35 t [iF�Mjactio- Only Depth —Vo . In* on Fill ted Numb of Bedrooms 4 —Design Flow G/P/b 800 'GPD 711101 Notificad is Required When Is �omvle er on Sieptl. Tank and- � '__- Supply: ---_,r` Frorn Address Adren or: x ate. Supply Drilled Oy Other Requirements I represent t I hat I' wholly and: coni-piete'ly responsible:for. t"ha,design and I ocation of'.the proposed system(s)..J) that the separate sewage d above described will be constructed a there to and in accordance With -the standards. rules nscifm Toe IAM C unty sit'sfactory'tiY the commissioner of Health will o Department of, H.alth, and that on completion iherioia-Certificate of Construction Com`piianc I _ submitted _- place in good operating condition any part of said iiwa4e, ciisposai system during. the peii0d of tvii�c! (2) years imrriediately following thedate of the issu ance of the approval of the C I ertificate of Cons I tructiori4"C-omplianice of -the'original s s tam or any'ripairi fhereto; 2) that the drilled well described above will be located as shown on.the d' "=, ^ app��~* = rules and regurallonsof. th46 Putnam County Department of Health. Date 7_2 ida"A4 signed 37. Fai Address Qqshin Assoc C, t, S;C./CqMe1,N.t —License No 26008-- APPROVED FqR CONSTRUCTION: 'This approval experespnei year'fronAt6a data issu o unless' c a building has been undertaken and is revocable for fese Wrkn be amer cled or modified when coMidert, 6' 'ry � ` Date Title _ ,_--- -''--'—.--- ------'_-__-~_-_--_°-~��~- .7-'-___'._--__---_�_---_�^ y PUTNAM COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS y DATE: I- .I....I i o c e- � � -� C-,:- 1-,f C � � i '� � � I� INSP. BY: (Nine of Owner) (Street Location) INITIAL SITE INSPECTION YES1 N01 COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Willdriveway need cut ............................ Must trees be rived - note these ................ Deep holes representative of entire SDS area., ..... Additional -deep holes needed..... . .... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics ............................ D.H. -Deep Hole G.W. - Groundwater D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot Depth to G. W. Depth to G. W. Depth to G.W. Depth to rock Depth to rock Depth to rock Soil uescri 0 ft. 3 ft. 6 ft. 9 ft. .on Soil 0 ft. 3 ft. 6 ft. 9 ft. Soil Descri tia 0 ft. 3 ft. 6 ft. 9 ft. DATE: FINAL SITE INSPECTION INSP.BY: Y YES N NO C COMMENTS House SSDS located per approved plan. ..b....... C C_5 I � ivan ha 1K Slope of tile line and trench acceptable......... X X <X Room allowed for expansion trenches .............. < Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ............. ... ........ 10 ft. maintained from property line and 20 ft. from house .............................. +.l Distance well to SSDS (ft.) ...................... + X, Number of bedrooms checks ........................ X Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench.. ........... � I I_ 15 ft. of peripheral soil horizontally � Boxes properly set ............................... k h h 2 C � in M 0S Could surface runoff from driveway, roads, k it Putnam County Department of Health Division or Environmental Sanitation AFFIDAVIT -- CORPORATE (XINER APPLTCATTON FOR PERMIT APPLICATION SUBMTTTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of HeEtlth - In the matter of application for ES-rATE�' — — — — — — - -- — — — — ---=------------- I, — — — — — — — — — — — — — — — — — - — — ,represent that I am an officer or employee of the corporation and am authorized to act for I /►� 7 — — — — — — — — — - - — — — 1 7 - — — — — — — — — — — (name of corporation)— — having offices at -44 O&P—T AY' — ----- — _ -- -- — — — — — — — — — — — — — — — — — Whose officers are President 11 — — — (Name and Address) — — — — — — — es) — Vice-President -- — — — — — — (Name and Address) Secretary (Name and Address) Treasurer " (Name and Address) and that I am and will be individually responsible for any or all acts of the corporation with respect to the approval. requeste a d all sub- 'equent"acts , r ing thereto ;d sequent:,qcts!;r.pl_ ing,.thereto. _,e 0 w e - �1—_— --, rn 0 efope thi Sworn to thi day Signeq---. — — — — — — — — — -- of 19 Title C4= _L — ----- - - - - -- N VG a o Corporate Seal PUTNAM .._,JUNTY DEPARTMENT OF HEALTH �--" DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING _.,Y.CARMEL, .—STGN DATA SHEET- SEPARATE, SEWAGE DTSPOSAL SYSTEM FILE NO. :. ciwner'_ 1 rO TES It�aG.. tiddre•sr l �� � . -ri� A%/ . C ' LQI�,: PJ Y W �cc� PEcz GT. _� _ .� :.. - taS2; Located at ( Street 0&CAWArr A- I +hs- Ro. Sec . 35" Block �Indicate nearest cross street) ?anicipa lit y PUTMAM yALL.L y' Watershed_ C.RO"i'y (V SOIL PERCOLATION TEST DATA RE-QUIRFD. TO BE SUBMITTED. WIN --.,A 3 2-So - 2- 3c1 __:umE.)er• CLOCK TIME PERCOLATION _.PERCOLATION I ?uri lapse ep i to • a er Water ve tdc�• Time From Ground' Surface in Inches.. -'Soil Rate Start -Stop Min. Start Stop Drop in Ain./in drop Tnches Inches Inches -- '2.22 -23I _ 2-3 ► ��.2,21 _ 2- Zy 3 2-So - 2- 3c1 5 - -- - - Notes: 1) Tests to be repeated at same depth until e�ppproximately equal soil rates are obtained at each percolation test hole. All data to be submitted for, review. 2) Depth measurements to be made from top of hole. e TEST PIT DATA REQUIRED TO BE SUBMITTIM WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO HOLE NO. G.L. 6u 181 `4 n 42" , 511 60" 66" 72 78.. 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED.''. INDICATE LEVEL TO WHICH WATER LEVEL RISES. AF-TER... BEING ENCOUN TES'T'S /�: _ .. _ _ r .._ ..... _ �. �. - Date ....._ .._.. _ MADE �BY_- _ � �.� Y< DESIQN Soil Rate Used0 -6- Min/1 "Drop: S.D. Usable Area j,-- No. of Bedrooms 3" Septic Tank Capacity' a Absorption Area Provided By -2!Q L. F. x24" �5s "''= wditrpnc . Other Address 3;7 F��R S� SEA - nj4: rI THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq.' Ft; /Cal. Checked by 17ate PUINAM OOLWN • DEPARnIERr OF HEALTH `DIVISION OF IWIROIMENTAL HEALTH SERVICES Date'... -7 -, /rz�& .. . , Re: Property of lXJE'C�> , , "14C, Located at (T) Oki�A V A LLE"Section S Block ' lot ' -2" Subdivision oflc. _Z � � `t Ofd tcc- l3 100 5ubdv. L'ot. �� � Field Map �� Date � Gentlemen'-. This letter is to authorize C a duly-licensed Professional Engineer or.Re iz istered Architect to ICATE- ,K; apply- for a.Constsuctibn.Permit f6r a separate sewage system, to serve the above noted property in accordance-with the standards, rules or .regulations as promulgated by the Coamissioner of the Putnam County.Department of Helath, and to sign all -necessa-sy papers an my behalf in connection with this matter and to supervise the .constructioa of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the- Public Health Law, and the Putnam meaty 'Saiiitary Code. Countersigne 37 t'AtP_ 'CAP_ jA_(C- L. ess 22s-� Te ep .0 Very. truly. yours , SIED -A GN ' l % ✓.� of roperty Address y CASHIN ASSOCIATES, P.C. _ HUDSON VALLEY DIVISION Architects o Engineers a Surveyors 37 Fair Street, Carmel, New York 10512 (914) 225 -8088 CABLE: CASHASSOC MINEOLANEWYORKSTATE MAY 29,1986 Mr. Jack Karrell Putnam County Department of Health County Office Building Carmel, New York 10512 Dear Mr. Karrell: Please find enclosed four (4) copies of Wiccopee Estates (II) Lot #5 and (I) Lot #3 with revisions as per your telephone call on May 27, 1986. Also enclosed are Authorization Forms and New Construction Permits for both Lots. Very truly yours, CASHIN ASSOCIATES, P.C. By A�JA a/ I - G'ary A. Tretsch GAT /g j 1 Enclosures _l 6o7- - - --------- ---------- - ------ I�x Q S' -+ x15? CL P- IN Q N m -P I�x Q S' -+ x15? CL P- IN Q ca` i u r - I I I I ouT I.ET In li tnlN.) OUTt.ET CauLU.,x I Fe-& 679!4\,VL. I 3c�1. �I.2-S' d.g�. 53' S�• �' 103,5, fig,.... , ,;T3.�, %':: 57� r - I I I I ouT I.ET In li tnlN.) OUTt.ET CauLU.,x I Fe-& 679!4\,VL. I